Healthcare Provider Details

I. General information

NPI: 1871688218
Provider Name (Legal Business Name): CHERYL A B CANFIELD D. O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 04/27/2022
Certification Date: 04/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

660 VOLZ CT
SEBEWAING MI
48759-1624
US

IV. Provider business mailing address

660 VOLZ CT
SEBEWAING MI
48759-1624
US

V. Phone/Fax

Practice location:
  • Phone: 989-551-9088
  • Fax: 989-954-3585
Mailing address:
  • Phone: 989-551-9088
  • Fax: 989-954-3585

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberCC010859
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: